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Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India

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  • Raj Parikh

    (Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston University Medical Center 72 East Concord Street, R304, Boston, MA 02118, USA)

  • Sowmya R. Rao

    (Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA)

  • Rakesh Kukde

    (Lata Medical Research Foundation, Nagpur 440002, India)

  • George T. O'Connor

    (Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston University Medical Center 72 East Concord Street, R304, Boston, MA 02118, USA)

  • Archana Patel

    (Lata Medical Research Foundation, Nagpur 440002, India)

  • Patricia L. Hibberd

    (Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA)

Abstract

Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p -value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p -value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p -value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p -value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p -value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.

Suggested Citation

  • Raj Parikh & Sowmya R. Rao & Rakesh Kukde & George T. O'Connor & Archana Patel & Patricia L. Hibberd, 2020. "Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India," IJERPH, MDPI, vol. 18(1), pages 1-11, December.
    • Handle: RePEc:gam:jijerp:v:18:y:2020:i:1:p:183-:d:469873
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    References listed on IDEAS

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    1. Megan L. Benka-Coker & Maggie L. Clark & Sarah Rajkumar & Bonnie N. Young & Annette M. Bachand & John R. Balmes & Robert Brook & Tracy L. Nelson & John Volckens & Steve J. Reynolds & Ander Wilson & Ch, 2018. "Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women," IJERPH, MDPI, vol. 15(11), pages 1-16, November.
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